Teriparatide products — Medical Mutual
Osteoporosis in men with primary or hypogonadal osteoporosis to increase bone mass
Initial criteria
- Patient has a T-score at or below -2.5 at lumbar spine, femoral neck, total hip, and/or 33% radius OR has had an osteoporotic or fragility fracture OR has low bone mass (T-score between -1.0 and -2.5) and physician determines high fracture risk
- AND patient has tried an oral bisphosphonate with inadequate response, fracture while on therapy, or intolerability; OR cannot take oral bisphosphonate due to inability to swallow, remain upright, or pre-existing GI condition; OR has tried zoledronic acid injection (Reclast); OR has severe renal impairment (CrCl <35 mL/min), CKD, or has had osteoporotic/fragility fracture
- AND use of Teriparatide/Tymlos does not exceed 2 years per lifetime
Reauthorization criteria
- Continuation is allowed if therapy has not exceeded a maximum lifetime duration of 2 years.
Approval duration
1 year (initial); 1 year (reauth); max 2 years total